Macco Law Group, LLP

‘Surprise’ medical expenses are an overwhelming burden

‘Surprise’ medical expenses are an overwhelming burden

Dealing with a major illness or injury is something that most people in New York find distressing. However, even after treatment, the stress can come back to haunt one financially in the form of “surprise” medical expenses.

According to one survey of non-elderly insured adults with problematic medical expenses, out-of-network charges were an issue in approximately one-third of the cases. Moreover, almost seven out of 10 of those facing unaffordable out-of-network medical expenses were not aware when they received care that the medical professional treating them was not in-network. These inadvertent medical costs are referred to as “surprise” medical expenses.

Surprise medical expenses can be incurred in a number of ways. For example, when a person goes to the emergency room, even if they know the hospital is in-network, they are not given the opportunity to choose a physician they know is also in-network. Other surprise medical bills are incurred when other medical professionals, such as anesthesiologists or radiologists, who are not in the same network as the patient’s in-network provider, treat the patient.

For patients who have health insurance, there are two parts to a surprise medical bill. The first part involves the percentage the patient is responsible for in-network versus what they would be responsible for out-of network. The second part involves what is known as “balance billing,” in which patients are charged for the balance of the out-of-network care along with any cost-sharing that may also be applicable in their situation.

Lawmakers have recognized that surprise medical expenses are a problem. Under New York law, if the individual seeking emergency care is covered by a state-regulated health insurance, they are only responsible for the applicable in-network cost sharing. For non-emergency care, individuals who incur a surprise medical bill from an out-of-network provider can fill out a form that gives the provider the permission to directly bill the individual’s insurance, after which the individual is only responsible for the in-network cost sharing that applies to their case. In either case, balance billing is prohibited.

For individuals suffering under the burden of surprise medical expenses, digging their way out of the financial hole may seem impossible. However, there are debt relief options such as filing for bankruptcy that may help some overcome these financial hurdles.

Source:, “Surprise Medical Bills,” Karen Pollitz, March 17, 2016